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Mr. Hutton: I certainly accept that, and I have taken part in some of the discussions with the BMA on precisely that issue. In the light of the new agreement, we clearly need to continue to discuss it with the association. I am talking here about the general principle, however, rather than about how the details of the payment mechanisms are working.
Mr. Lansley: It is in the contract, on page 8.
Mr. Hutton: It is, but it is also clear from paragraph 2.11 of the agreement that we shall continue to discuss the detail of those arrangements with the BMA. That is the only point that I am trying to make.
The second of the two principal purposes of these amendments is to make changes to the legislation on personal medical services—the alternative to general medical services. We have already considered the amendments necessary to implement the agreement between the BMA and the NHS Confederation for a new GMS contract. We have also looked at the new duty on PCTs to provide or secure the provision of primary medical services as set out in proposed new section 16CC. This will have an impact on other areas of primary care, including PMS schemes. The intention of new clause 29 and amendments Nos. 278 to 283 is, therefore, to provide the legal basis for changes to PMS that are, in the main, consequential to the new GMS contract.
We are taking the opportunity to bring local PMS contracts into the mainstream of primary medical services. It is our intention that all existing PMS pilots will become mainstream with effect from 1 April 2004. The National Health Service (Primary Care) Act 1997, which was introduced by the previous Conservative Administration and supported by the then Labour Opposition, introduced the concept of personal medical and dental services, and inserted new sections 28C, 28D and 28E into the 1977 Act. However, the concept was considered at the time to be very different from the traditional national GMS agreements, so a period of piloting was provided for in part 1 of the 1997 Act.
Personal medical service pilot schemes are voluntary—rightly so—and are intended to give GPs, nurses and primary care trusts the flexibility and opportunity to innovate by offering different options for addressing primary care needs that have to be met locally. It was always the intention, however, that, provided that PMS proved successful, the system would be made permanent. It has proved to be successful and we are therefore repealing part 1 of 1997 Act in respect of England and Wales. PMS will continue under the permanency arrangements that were set out in the 1997 Act. In other words, the legal basis of PMS switches to sections 28C to 28E of the 1977 Act. This also applies to personal dental service arrangements.
This means that decisions can be made locally rather than nationally about individual schemes, now that we have moved beyond the pilot phase. The House will be aware that individual PMS schemes need to be approved by Ministers, but I believe that that is no longer necessary, and that we can move beyond that sort of centralism. The intention is that under the general transitional powers in the Bill we will issue an order that allows existing PMS agreements to continue, but automatically changes the legislative basis of those contracts to the 1977 legislation. All things being equal, that will have no impact at all on PMS providers unless there are variations to their PMS agreements. We are also making a number of other changes to the provisions in sections 28C, 28D and 28E, which are largely technical and reflect some of the changes brought about by the new general medical services contract provisions.
6.30 pm
That concludes the formal substance of my remarks, but I think that this is an important moment for primary care. We have had a strong, positive endorsement of the new contract from family doctors, and the House now has the means to give effect to it. I hope that Members on both sides of the House will support our new clauses, which command the support of the BMA and the NHS Confederation.
Mr. Burns: May I begin by thanking the Minister? In Standing Committee, it emerged that large parts of the Bill relied heavily on the Government's regulation-making powers. We did not know how the Government intended to use regulations to build on the nuts and bolts of the Bill—this is not a criticism—because they were not yet in a position to share their views with Opposition parties or anyone else. However, towards the end of proceedings in Committee, the Minister said that he would seek to introduce new clauses and amendments on Report to incorporate the GP contract in the Bill, and gave a commitment to make available to Committee members explanatory notes and a briefing on the Government's proposals. That commitment was honoured, and the briefing and notes arrived yesterday morning. Of course, it would have been better and more convenient to have them over the weekend, but not getting them then was not the end of the world. In the first post yesterday we received an extensive briefing from the Minister, which will certainly assist us during today's proceedings. I thank the Minister for going to the bother of keeping us informed.
As the Minister will be aware, five new clauses and 32 amendments have been tabled on the GP contract, so incorporating it in primary legislation constitutes an
extensive addition to the Bill. The Minister was factually correct when he said that it had taken two years to get a GP contract, but he did not say that it had had a chequered history. The Government have had to make significant changes to the initial contract that they hoped to persuade GPs to accept. Dr. John Chisholm, chairman of the BMA's general practitioners committee said:
- "The profession has given a clear mandate for change. A large majority of general practitioners—eight out of ten—want the new contract to be introduced".
- "While I am delighted by the overwhelmingly supportive vote in favour of the new contract, I am in no way complacent. The negotiations have been difficult and there are GPs who do not have confidence in parts of the new contract. The negotiating team is in no doubt what their concerns are and there is much work to be done during the implementation phase of the contract. This will begin immediately."
I do not want to detain the House for long, but I should like to raise a number of matters with the Minister. If he catches Madam Deputy Speaker's eye and responds to my questions later in the debate, I shall be grateful; equally, given the time pressure on our proceedings, I shall fully understand if he thinks it better to write to me rather than using up time that other hon. Members could use to contribute to the debate.
First, as the Minister's briefing and the amendments demonstrate, the proposals, like other proposals that we debated earlier, will involve considerable regulation-making powers. I suspect that I will get the same old answer, to the effect that those powers will be subject to the negative procedure rather than the affirmative, but I would appreciate it if the Minister confirmed that my assessment is right. I will not repeat the speech that I made a little earlier about the affirmative procedure, save to say that, as, sadly, the sadly was not here for my contribution, I would immodestly recommend for once that he read it tomorrow—[Interruption.] I am grateful to my hon. Friend the Member for Tatton (Mr. Osborne), who obviously enjoyed my speech and understood the wisdom of it, but I shall spare the House a repetition—the Minister can read it.
The Minister has said that the measures before us will simplify the legislative base—despite the new delegated powers, the overall volume of delegated legislation after implementation will be less than it is now. I would welcome confirmation that that is the case, but I am intrigued to learn how regulation will be reduced. I am old enough to have heard Governments of all political persuasions claim that there will be less regulation, and that less regulation means better government. I am cynical about those claims because, when it comes to the crunch, they are never realised. I would appreciate the Minister's comments on that.
I should now like to deal with one or two specific issues arising from new clause 26. Subsection (4) of proposed new section 16CC, as the Minister will know, specifies that a PCT or a local health board must
- "co-operate with any other such body in the discharge of their respective functions".
Turning to enhanced services, new clause 27 inserts a number of new sections into the National Health Service Act 1977. The Minister referred to the changes that the Government will make to that Act through their amendments. However, the explanatory notes state that under proposed new section 28Q, a general medical services contract is a contract for primary medical services, as specified in paragraph 2.8 of the new GMS contract. However, it may also include enhanced services on the boundary of primary and secondary care such as specialised services in areas like drug and alcohol misuse, sexual health and depression. Where the new GMS contract does not provide for enhanced services, will the Minister confirm how and by what mechanism those services will be available to patients? I am sure that he will agree that this is a matter of critical importance. From the outset, there must be no misunderstanding about how the Government envisage this part of the Bill working.
On the question of pay, proposed new section 28T allows the Secretary of State or the Welsh Assembly to make directions regarding payments to be made under the new contract. Will those directions provide for the minimum income guarantee? Can the Minister confirm that the Government do not intend to place a time limit on the minimum practice guarantee? Again, if the Minister can give some more information on that point, it will go a long way towards satisfying our quest for knowledge and will send a message beyond this Chamber to those who may have some concerns or uncertainty about what is a very important matter and a crucial part of the contract.
Finally, proposed new section 28T(3) states that the payments will be made
- "by reference to compliance with standards or the achievement of levels of performance".
The Minister will be relieved to hear that I do not intend to reopen the debate pursued with such skill in our Opposition day debate yesterday by my right hon. and learned Friend the Member for Folkestone and Hythe (Mr. Howard), the shadow Chancellor, and by
my hon. Friend the Member for Woodspring (Dr. Fox), the shadow Secretary of State for Health. I do not want to cause the Government embarrassment for a second day running, but I should be grateful if the Minister would expand on the question of targets.In his concluding remarks, the Minister said that he hoped that hon. Members on both sides of the House would accept the Government amendments and, in effect, the new GP contract. I assure him that the Opposition broadly accept the GP contract. I have no intention of asking Opposition Members to divide the House on this matter. However, I should be grateful if the Minister will provide me, when it is practicable and sensible to do so, with answers to my questions.
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